RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

SEPARATION DATE:  20040309 

                          BRANCH OF SERVICE:  ARMY 

 
NAME:  XXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1201099                             
BOARD DATE:  20130125 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was a mobilized Reserve SPC/E-4 (88M/Driver) medically separated for 
hypertension.  Increased blood pressure was first identified in early 2003 and despite extensive 
testing and medication the CI could not be adequately rehabilitated to meet the requirements 
of  her  Military  Occupational  Specialty  or  physical  fitness  standards.    She  was  consequently 
issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The blood 
pressure condition, characterized as “Uncontrollable essential hypertension,” was forwarded to 
the  Physical  Evaluation  Board  (PEB)  as  medically  unacceptable  IAW  AR  40-501.    Two  other 
conditions (identified in the rating chart below) were addressed by the MEB and forwarded as 
medically  acceptable. 
  The  PEB  adjudicated  “Hypertension,  with  diastolic  pressure 
predominantly  110  or  more”  as  unfitting  and  rated  20%.    The  CI  made  no  appeals  and  was 
medically separated with that disability rating. 
 
 
CI CONTENTION:  “At the time of my discharge my blood pressure was extremely high and after 
several  attempts  with  different  medications  my  pressure  still  had  not  been  controlled  + 
migraine headaches were unbearable therefore I could not perform my duties.” 
 
 
SCOPE  OF  REVIEW:    The  Board  wishes  to  clarify  that  the  scope  of  its  review  as  defined  in 
Department of  Defense Instruction  (DoDI)  6040.44  Enclosure  3, paragraph  5.e.2  is  limited  to 
those conditions which were determined by the PEB to be specifically unfitting for continued 
military service or, when requested by the CI, those condition(s) “identified but not determined 
to be unfitting by the PEB.”  The rating for the unfitting hypertension is addressed below.  The 
requested condition of migraine headaches, which was determined to be medically acceptable 
by the MEB, is likewise addressed below.  Any conditions or contention not requested in this 
application or otherwise outside the Board’s defined scope of review remain eligible for future 
consideration by the service Board for Correction of Military Records. 
 
 
RATING COMPARISON:   
 

Code 
7101 
Medically Acceptable  Migraine headaches 
Medically Acceptable 

VA (9 Mo. Post-Separation) - 20050307 VARD 
Rating 
Condition 
10%* 
Hypertension 
30%* 

Service PEB – Dated 20040205 
Condition 
Hypertension… 
Chronic Daily Headaches 
Mild open angle glaucoma 
No Additional MEB/PEB Entries 
Combined:  20% 
* Hypertension (7101) increase to 40% and Migraine (8100) increased to 50% effective 20040310 from DRO rating of 20060416 
and exams of 20060103 (combined 70%) 
 
 
 

Exam 
20041201 
20041201 

Combined:  30%* 

Code 
7101 
8100 

 

Rating 
20% 

NSC x 2 

20041201 

ANALYSIS SUMMARY: 
 
Hypertension  Condition.    The  CI  was  diagnosed  with  hypertension  after  having  severe 
headaches and chest pain.  Despite extensive evaluations and multiple medication regimes her 
hypertension  and  headaches  continued.    She  was  seen  numerous  times  for  emergency 
department  treatments  and  both  the  narrative  summary  (NARSUM)  and  VA  exam  histories 
detail  the  evaluation  for  underlying  causes  of  malignant  hypertension  including  cardiac  and 
renal artery catheterization, echocardiogram and head CT scan.  The NARSUM, PEB-requested 
multi-day blood pressure check, the service treatment record (STR) and VA records and initial 
VA Compensation and Pension (C&P) exam (9 months after separation) proximate to separation 
demonstrated diastolic blood pressures predominately above 110, but very rarely up to 120.  
Blood pressure was poorly controlled, but there was no evidence of hypertensive heart disease, 
or renal pathology prior to separation.  The C&P exam performed 22 months after separation 
demonstrated  worsening  of  the  CI’s  hypertension  and  numerous  occasions  when  diastolic 
pressure was 120 or more on 12 March 2004 (3 days after separation), 30 September 2004 and 
eight times between April 2005 and September 2005.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
Board  considered  that  the  evidence 
indicated  post-separation  worsening  of  the  CI’s 
hypertension  and  there  was  insufficient  evidence  of  diastolic  pressure  predominantly  120  or 
more proximate to separation to support a higher rating.  After due deliberation, considering all 
of  the  evidence  and  mindful  of  VASRD  §4.3  (Resolution  of  reasonable  doubt),  the  Board 
concluded that there was insufficient cause to recommend a change in the PEB adjudication of 
the hypertension condition.  The Board concluded therefore that this condition could not be 
recommended for additional disability rating. 
 
Contended PEB Conditions (Chronic Daily Headaches).  The Board’s main charge with respect to 
the headache condition is an assessment of the fairness of the PEB’s implied determination that 
it  was  not  unfitting;  the  PEB  did  not  specifically  address  the  MEB’s  “medically  acceptable” 
assessment  of  the  headache  condition.    The  Board’s  threshold  for  countering  fitness 
determinations is higher than the VASRD §4.3 (Resolution of reasonable doubt) standard used 
for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” 
standard.  The P3 profile listed malignant hypertension, and the headache condition was not 
separately  specified  in  the  profile.    The  commander’s  statement  mentioned  malignant 
hypertension, but headaches  were  not  separately  implicated in the  commander’s  statement.  
However, the NARSUM examiner indicated “based off of the (CI’s) inpatient, ER, outpatient and 
specialty  evaluations,  this  solider  was  found  to  not  meet  AR  40-501  criteria  for  her…chronic 
daily  headaches.”    From  March  through  July  2003  the  CI  was  prescribed  migraine  headache 
relief medications, such as Percocet, Fentanyl, Mobic, Methocarbamol, Morphine, Maxalt, and 
Lmitrex.    However,  after  this  period,  medication  treatment  for  the  chronic  daily  heads  was 
limited due to the uncontrolled hypertension condition. 
 
The  CI’s  headache  condition  had  onset  with  the  CI’s  hypertension  condition  and  neurologic 
specialist  evaluation  indicated  the  CI’s  continued  ongoing  headaches  was  “diagnosed  as 
migraine with transformation into rebound headaches.”  The NARSUM examiner stated “The 
(CI) was not treated with migraine medications because I felt that her headaches were most 
likely  due  to  her  uncontrolled  hypertension  and  not  from  migraine  as  well  as  triptan 
medications  being  contraindicated  in  the  presence  of  uncontrolled  hypertension.”    The 
preponderance  of  the  treatment  notes  for  hypertension  included  the  complaint  of  daily  and 
severe  headaches.    There  were  three  emergency  room  visits  for  hypertension  with  other 
symptoms  in  the  year  prior  to  separation.    The  very  significant  profile  restrictions  for  the 
malignant  hypertension  condition  and  examiner’s  clearly  relating  the  headaches  to  the 
hypertension  made  it  difficult  to  separate  specific  functional  restrictions  for  hypertension  or 
headaches due to hypertension.  The STR did not provide sufficient detail of the severity and 

2                                                           PD1201099 
 

frequency  of  the  CI’s  headaches  aside  from  “chronic  daily,”  “10/10,”  “9,”  and  “severe 
headache” to determine a precise frequency of prostrating versus non-prostrating headaches.  
The VA exam, 9 months after separation, indicated a history of headaches since March 2003, 
and stated “She (the CI) has these headaches 4 times a week and her pain will increase to a 10 
and last for 8-12 hours.  Functionally she reports she is bed bound when she has the severe 
headaches.”  The VA rated that exam at 30%. 
 
The Board directs attention to its recommendation based on the above evidence.  There was 
detailed  deliberation  concerning  the  functional  impact  of  the  headache  condition  on  duty 
performance and the unfit versus fit determination.  The STR was scrutinized for both headache 
history  and  medical  interventions  to  try  to  control  headache  symptoms,  separate  from 
hypertension medical management.  Likewise the linkages between the malignant hypertension 
and  headaches  and  headache  treatments  were  discussed.    The  Board  also  discussed  the 
standard of evidence required to find the headache condition as an unfitting and compensable 
condition. 
 
After due deliberation, the Board majority agreed that the preponderance of the evidence with 
regard to the functional impairment of the chronic daily headache favors its recommendation 
as  an  additionally  unfitting  condition  for  disability  rating.    The  Board  majority  adjudged  that 
there was sufficient evidence of prostrating attacks occurring at an average of one in 2 months 
over  the  several  months  prior  to  separation  to  meet  the  10%  rating  criteria.    The  Board 
adjudged there was post-separation worsening and insufficient prior to separation evidence to 
support the higher 30% rating criteria.  The Board majority therefore recommends a disability 
rating of 10% for the headache condition coded 8199-8100 IAW VASRD §4.124a. 
 
 
BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or 
guidelines relied upon by the PEB will not be considered by the Board to the extent they were 
inconsistent  with  the  VASRD  in  effect  at  the  time  of  the  adjudication.    The  Board  did  not 
surmise  from  the  record  or  PEB  ruling  in  this  case  that  any  prerogatives  outside  the  VASRD 
were exercised.  In the matter of the hypertension condition and IAW VASRD §4.104, the Board 
unanimously recommends no change in the PEB adjudication.  In the matter of the contended 
headache condition, the Board by a vote of 2:1 agrees that it was unfitting and recommends a 
disability  rating of 10%,  coded  8199-8100,  IAW  VASRD §4.124a.   The  single  voter for  dissent 
(who recommended the headache condition be found not unfitting) submitted the appended 
minority  opinion.    There  were  no  other  conditions  within  the  Board’s  scope  of  review  for 
consideration. 
 
 
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows;  and,  that the discharge  with  severance pay  be  recharacterized to  reflect  permanent 
disability retirement, effective as of the date of her prior medical separation: 
 

8199-8100 
COMBINED 

20% 
10% 
30% 

UNFITTING CONDITION 
Hypertension, with Diastolic Pressure Predominantly 110 or More  7101 
Chronic Daily Headaches 

VASRD CODE  RATING 

 
 
 
 
 

3                                                           PD1201099 
 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120703, w/atchs. 
Exhibit B.  Service Treatment Record. 
Exhibit C.  Department of Veterans’ Affairs Treatment Record. 
 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXX, DAF 
           Acting Director 
           Physical Disability Board of Review 

4                                                           PD1201099 
 

MINORITY OPINION: 
 
The Minority concluded that the 20% rating adjudicated by the PEB was appropriate due to the 
documented  evidence  that  best  described  the  medical  condition  of  the  CI  on  the  date  of 
separation.  No information in the majority opinion demonstrates a preponderance of evidence 
indicating headaches were a separately unfitting condition. 
 
No  evidence  in  the  record,  other  than  post-separation  self-reporting  at  the  VA  exam, 
documents  prostrating headaches  in  the  last  several  (or  even  11)  months  of  service  prior  to 
separation.  One exam dated 20 March 2003 (almost a year prior to separation) reported a visit 
to  the  emergency  room  (ER),  after  the  fact,  due  to  headaches;  this  exam  could  clearly  be 
interpreted to indicate “prostrating” headaches.  No exam or treatment after 9 April, 2003 (11 
months  prior  to  separation)  reported  headache  pain  (10/10)  during  the  exam;  there  were 
exams  or  treatments  that  mention  headaches  occurring  at  other  times,  but  no  reference  to 
anything resembling a prostrating headache.  In fact, during an exam on 1 June 2003, the CI 
“states  compliance  with  BP  meds.    Denies  HA/SOB/Dizziness”  (SOB  meaning  shortness  of 
breath).  At an exam on 28 July 2003, the CI reported “some h/a off & on” with a pain scale of 
4/10.  At the 30 July 2003 consult for headaches, the Neurologist wrote in his report “Curiously 
when I ask her how severe the headache is, she tells me she actually has no headache.”  The 
closest to separation of anything that could be construed as a “prostrating headache” would be 
the single ER visit for headaches reported during the exam on 20 March 2003. 
 
As  acknowledged  above,  neither  the  commander’s  statement  nor  the  P3  profile  mention 
headaches  as  a  cause  of  the  move  towards  medical  separation.    This  is  likely  because  there 
were no lost workdays, no stopping work to seek treatment for headaches in roughly the year 
prior to separation.  While the NARSUM examiner did in fact state the patient “does not meet 
AR  40-501  criteria  for  her  uncontrollable  hypertension,  her  chronic  daily  headaches,  and 
glaucoma,” this same physician was a member of, and signed the Record of Proceedings for, the 
MEB  that  diagnosed  the  headaches  and  glaucoma  as  being  medically  acceptable.    The  C&P 
exam 9 months after separation includes self-reported prostrating headaches not corroborated 
by service records. 
 
Rather  than  a  preponderance  of  evidence  demonstrating  headaches  as  a  separate  unfitting 
condition, the clear preponderance of evidence, and all objective evidence, indicates headaches 
at a not-unfitting level.  Additionally, it is plain that prostrating headaches are not evidenced in 
service records during the majority of the year prior to separation; to conclude an average of 
one prostrating headache every two months is unsupported by the evidence. 
 
The minority recognizes the dedicated service to the nation by the CI as well as the pain and 
discomfort  brought  on  by  her  medical  condition.    Neither  the  evidence  of  record  nor  the 
information  as  presented 
in  the  report  of  the  majority,  however,  demonstrates  a 
preponderance of evidence that the headaches were separately unfitting.  The minority finds 
the PEB made an accurate and fair rating of 20% disability based upon the VASRD rules in effect 
and the medical condition at the time of separation. 
 
RECOMMENDATION:    The  Board  minority  recommends  no  recharacterization  of  the  PEB 
adjudicated disability and separation determination, as follows: 
 
UNFITTING CONDITION 
Hypertension, With Diastolic Pressure Predominantly 110 or More 
Chronic daily headaches 

VASRD CODE  RATING 

Not unfitting 

20% 

20% 

 

 

5295 

COMBINED 

5                                                           PD1201099 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXX, AR20130003033 (PD201201099) 
 
 
1.  I have reviewed the enclosed Department of Defense Physical Disability Board of 
Review (DoD PDBR) recommendation and record of proceedings pertaining to the 
subject individual.  Under the authority of Title 10, United States Code, section 1554a,  
I reject the Board’s recommendation and accept the Board’s minority opinion as 
accurate that the applicant’s final Physical Evaluation Board disability rating remains 
unchanged.  There is insufficient justification to support the Board’s recommendation in 
accordance with Army and Department of Defense regulations. 
 
2.  This decision is final.  The individual concerned, counsel (if any), and any Members 
of Congress who have shown interest in this application have been notified of this 
decision by mail. 
 
BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 
 

     XXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

6                                                           PD1201099